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Showing posts with label Medicare benefits. Show all posts
Showing posts with label Medicare benefits. Show all posts
Posted by Aneesh Chopra on October 29, 2009 at 09:52 AM EDT A national health care computerized system is needed. In Medicare alone fraud costs the taxpayers $60 to $90 billion every year. Miami, FL is a hotbed of Medicare fraud. Once medical records are automated and computerized, it will be much easier for the government to catch fraud.
The Health IT Standards Committee within the Department of Health and Human Services will begin an unprecedented effort to get the public’s view on how our work might "pull forward" the benefits of healthcare information technology (IT).
Specifically, we’re interested in uncovering new strategies to accelerate the adoption of health IT standards. This effort began with the passage of the American Recovery and Reinvestment Act of 2009. It called for recommendations on standards to promote safe, secure, healthcare information exchange.
“Standards” are really the guardians of quality, consistency, and interoperability. Without thoughtful, clear and uniform standards, we cannot enable the seamless and secure exchange of electronic health information (or the benefits that accrue to providers and patients from such protected exchanges).
So, while the exploration of technical standards may seem mundane to some, it is foundational to electronic health records (EHRs) and electronic health information exchange more broadly. In other words, it’s worth paying some attention to, and voicing your opinions.
Our process continues with a public hearing today in Washington, DC. Find out how to participate via phone and webcast here. We are convening four panels of experts with on-the-ground experience in interoperability standards - providers, quality stakeholders, health IT vendors, and a group with lessons drawn outside of healthcare. Thanks to HIT Standards Committee member Judy Murphy for her leadership on this effort.
The conversation through an Online Forum over the next two weeks. Thanks to Committee Member Cris Ross for his leadership on this effort. We have arranged a series of Committee Member blog posts to begin the dialogue, starting with HIT Standards Committee Vice-Chair John Halamka's summary of our work to date, which will post on Friday. We will concurrently have ongoing discussion threads on the following topics:
1. Proposed Standards (General Discussion) 2. Interoperability 3. Vocabularies 4. Privacy 5. Security 6. Quality 7. Implementation Case Studies (Your Story - the good, bad and in-between)
We have also enabled a "voting" feature on submissions to allow you - the public - an opportunity to emphasize points raised in a given post. Our goal is to harness the shared wisdom of our community to inform the work of the HIT Standards Committee in the weeks and months ahead.
The process of accelerating the adoption of health IT standards will not end this week, this month, or this year. This is an ongoing effort, and your participation will continue to be essential to its success.
Aneesh Chopra is U.S. Chief Technology Officer
See a 60 Minutes article on this Medicare fraud: http://www.cbsnews.com/video/watch/?id=5419844n&tag=related;photovideo
Medicare Advantage was created during the Bush Administration as a private insurance option to Medicare recipients. The program is subsidised by the federal government. Medicare Advantage covers 19 per cent of Medicare beneficiaries. If you want a detailed overview of this program, see http://en.wikipedia.org/wiki/Medicare_(United_States)#Part_C:_Medicare_Advantage_plans
The House wants to cut some of the federal subsidies which will make Medicare Advantage less profitable for the health care industry.
Health insurance reform opponents continue to spread myths about America’s Affordable Health Choices Act, including saying that health reform will eliminate Medicare Advantage plans. America’s Affordable Health Choices Act continues Medicare Advantage plans, but eliminates wasteful taxpayers’ overpayments that increase private insurance company profits, not patient care.
The top five Medicare Advantage myths:
MYTH: Medicare Advantage plans run by private insurance companies have been able to provide better value to U.S. taxpayers than traditional Medicare.
FACT: According to the nonpartisan Medicare Payment Advisory Commission, US taxpayers pay 14 percent more on average to private Medicare Advantage plans to cover Medicare beneficiaries than it would cost traditional Medicare to cover them.
These overpayments to private insurers were created in the Medicare Modernization Act, which the Republican-controlled Congress passed in 2003 and President George W. Bush signed into law.
When the Medicare Advantage program was created, insurance companies said that they would offer coverage for less than it was costing the government under traditional Medicare to provide the same services. Today, this promise has been broken and the taxpayers are paying the price – these Medicare Advantage plans are receiving 14 percent more.
MYTH: The overpayments to private Medicare Advantage plans mean better coverage for seniors.
FACT: Very little of the extra money going to private plans under Medicare Advantage goes to beneficiaries. Most of these taxpayer funds are used to pad the profit margins of private insurers.
According to a study by the Robert Wood Johnson Foundation, only 14 cents for every extra dollar given to Medicare Advantage plans end up translating into additional benefits. The other 86 cents goes into the pockets of the insurance companies.
The independent Medicare Payment Advisory Commission notes that the quality of care of traditional Medicare users and MA users are fairly similar — while MA users actually reported more problems accessing specialists.
MYTH: The current system of Medicare Advantage plans, despite the overpayments, is a good investment for everyone – including America’s seniors.
FACT: Everyone pays the price for these overpayments – including the 77 percent of Medicare beneficiaries who are enrolled in traditional Medicare. According to the Chief Actuary for the Medicare program, seniors in traditional Medicare pay higher premiums to subsidize Medicare Advantage plans – a typical couple paying an additional $90 a year.
The Chief Actuary has also stated that the overpayments to the Medicare Advantage program speeds up the depletion of the Medicare trust fund by 18 months and threatens the long-term solvency of Medicare.
MYTH: Enactment of the House health insurance reform bill will mean the elimination of private Medicare Advantage plans.
FACT: The House health insurance reform bill does not eliminate Medicare Advantage plans – instead, it simply phases out the overpayments going to these plans. The Congressional Budget Office projects that most private Medicare Advantage plans would continue to operate, once the current overpayments are phased out.
Under the House bill, Medicare Advantage plans that are able to operate efficiently and provide extra value to their enrollees through care coordination will continue to flourish.
MYTH: Enactment of the House health insurance reform bill will lead to worse health care coverage for Medicare Advantage enrollees.
FACT: As noted above, most of the extra money going to private plans under Medicare Advantage – which the House bill phases out – does not go to seniors for additional benefits. According to the study by the Robert Wood Johnson Foundation, 86 percent of this extra money simply goes into the pockets of the insurance companies. Hence, the phasing out of these overpayments will mostly impact insurers’ extra profits – and not seniors.
Additionally, the House bill makes reforms to Medicare Advantage that will improve the coverage of care for seniors enrolled in those plans. Currently, some Medicare Advantage plans offer lower cost-sharing for drugs and vision care but higher cost-sharing for services such as hospitalizations and home health services. As a result, seniors can end up spending more out-of-pocket under a Medicare Advantage plan, not less.
The House bill contains key provisions that limit cost-sharing requirements in Medicare Advantage plans to the amount charged for the same services in traditional Medicare coverage – which can end up saving seniors enrolled in certain Medicare Advantage plans thousands of dollars.
